Improved survival for hepatocellular cancer with combination surgery and multimodality treatment.

Forty-one hepatic resections for malignant hepatomas were done in 35 consecutive patients from August 1985 to 1990. Twenty-one patients presented initially with resectable lesions and underwent resection for curative intent. Fourteen patients initially presented with unresectable intrahepatic disease. These patients underwent combined radiation and chemotherapy. Radiation consisted of external beam in all patients and 131I-antiferritin in 10 patients. Greater than 50% tumor reduction was noted in all patients, and resection then was performed. Six patients recurred and were re-resected. Complications occurred in 15 patients (36%), with no difference between groups. There were no perioperative deaths. Five-year actuarial survival was 45% and 48% for resection and multimodality. The authors conclude that some patients with unresectable intrahepatic hepatoma may successfully be converted to resectable by multimodality radiation/chemotherapy. The survival of these patients is similar to that of primary resected patients. Further, multiple, sequential resections appear to significantly prolong survival and can be performed with an acceptable morbidity and mortality rates.